The goal of the proposed project is to identify and assess the effect of certain environmental and patient care activities partially or wholly under nursing control in preventing the occurrence of acute confusional states (ACS) in elderly hospitalized patients. Achievement of this goal will be accomplished in three phases. The objective of Phase I is to develop a risk profile assessment tool (RPAT) that will promote the identification of persons at high risk of developing ACS at admission and at critical early points during hospitalization. Evaluation of the predictive validity of the tool will comprise Phase II. The objective of Phase III is to determine the effect of specified nursing actions in preventing the occurrence of ACS in patients of differing predicted risk levels. The patient population in all phases is that of persons over 60 years of age undergoing surgical repair of a traumatically fractured hip. In Phase I, a minimum of 170 patients will be followed from admission through the fifth post-operative day. Data will be collected by patient interview, mental status testing, direct observation, record review, blood studies, and questioning of staff. Variables to be considered include: demographic data, drug history, mental status, blood values, use of corrective sensory aides, environmental factors, mobility, hydration, drugs, temperature, pain relief, bladder problems and continuity of care. The dependent variable, ACS, will be measured on a behavioral basis. Statistical analysis will employ multiple regression. The RPAT will be constructed based on results of Phase I data analysis. Evidence for its predictive validity will be collected using an additional 40 patients. The same methods of data collection will be used. Results from Phase I and II will be used in constructing the procedures for use with an experimental group of 40 patients in two hospitals. Protocols will be designed to specify nursing activities and environmental manipulations to be followed from admission through the third post-operative day. Data collection will proceed in the same fashion as in Phase I and II.